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  • Title: Perioperative indicators of hypocalcemia in total thyroidectomy: the role of vitamin D and parathyroid hormone.
    Author: Salinger EM, Moore JT.
    Journal: Am J Surg; 2013 Dec; 206(6):876-81; discussion 881-2. PubMed ID: 24112673.
    Abstract:
    BACKGROUND: Hypocalcemia is a common complication of thyroidectomy. The aim of this study was to identify risk factors for this problem. METHODS: This prospective analysis included 111 patients undergoing total or completion thyroidectomy. Preoperative vitamin D levels and postoperative day 1 parathyroid hormone levels were analyzed for their predictive effects on postoperative hypocalcemia. RESULTS: Patients with ionized calcium <4.4 mg/dL had significantly lower mean parathyroid hormone levels than normocalcemic patients (13.0 vs 28.4 pg/mL, P < .001). Parathyroid hormone levels were also significantly lower in symptomatic patients (11.0 vs 28.4 pg/mL, P < .001). Preoperative vitamin D level, body mass index, gender, and pathologic findings were not associated with low calcium levels or symptoms of hypocalcemia. CONCLUSIONS: Younger age and low postoperative parathyroid hormone levels are predictive of symptomatic hypocalcemia. A parathyroid hormone level outside of the reference range may indicate a need for more aggressive postoperative calcium supplementation and treatment with activated vitamin D. Older patients with normal postoperative parathyroid hormone levels may be safely discharged with appropriate calcium supplementation.
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